Monday, May 16, 2005

A Place

There are many more patients awaiting us this morning than yesterday. I am assigned to help translate in pre-op. Patients are identified with surgical needs in the clinic, told to come back the next day after having not eaten or had anything to drink. Their names are called, and they are brought to pre-op, where we have them change into a hospital gown, they weighed, vitaled, reinterviewed, then given an IV.
Then they wait until surgery is ready for them. The nurse anestheists come down and reinterview them and have them open their mouths so they can guage how easy or difficult the intubation will be, then they are lead down to surgery.

I get my first chance to do an IV when one of the nurses misses, and I tell her I'll scope out the other arm for her. I point out a vein, and she looks at it, then tells me to do it if I think I can get it. I put the IV in, then ask her, if she has a preference on how it is taped down. They later have me do an IV on a child and on a darked skinned Haitian.

I admit to having some trouble with not being in charge. As a paramedic you are trained to take charge. Here I have to tiptoe around. I irk one of the anesthiests when moving a patient. I am used to moving a patient with just two people. They use six here. For a large woman, I suggest letting me grab her from the top, but he is at the head, and I learn the rule is the anesthist in the hospital is like the paramedic in the field -- they control the airway, even when the patient is alert. I make certain to stay at the feet end.

Coming down I had wondered if I would get the chance to intubate, but I see that I will not. With two anesthists in each room, they have that covered, and my job is outside the OR. When a cesearian comes in, Annie, the nurse running post-op, who is also a close friend of mine and who has worked with me for years on the ambulance, where she is a volunteer EMT-I, tells me to replace her in post-op. Her job will be to catch the baby and rescusitate it. She tells me later when they asked her to do the job, she told me I had probably had the most experience with rescusitaions and delieveries. They responded that they needed a nurse.

The good thing about it that when things get busy, if you can get the job done, then the job is yours. In post op, I take the report from the doctor and the anesthetist, then monitor the patient, vitaling every fifteen minutes for the first hour, then every half hour after that.

If they have pain, I can give them Morphine, phenergan for the nausea.

When they are stable, they are transported down the hall to a large room with many beds where their families can take care of them until they are ready to be discharged. I give many discharge instructions, handing them percocets and ibuprophren.

My friend tells me there is some grumbling from nurses about a non-nurse giving medicine, until she explains to them that it is something that I do all the time on standing orders.

The pace is hectic. I am constantly being called on to treat someone's pain, take a report on a new patient, answer a family members questions, translate for a doctor, move a heavy patient, do an IV on another child. The rooms are hot and humid. I am sticky with sweat. I make a point to drink as much water from the color as I can to stay hydrated. There are several ceasarians done, one child needs bagging and I am so busy I can only glimpse as my friend helps with the child's breathing, bagging, and then hitting her cupped hand against the infant's back.

We are the last to leave. The babies are all fine, the patients transfered down to the family room, where their family members wil look out for them, bringing clean sheets from home for the old mattreses, brushing their foreheads with moist towels, feeding them home-cooked food. I say good night to them all, and we walk back to the bus, and I feel that today I found my place. I won't get into the OR again, and I won't be there for the delieveries, but I have a job that is important, and I believe I have proved myself.


After dinner I go for a walk off the complex with Santiago, one of the Dominicans, Nancy, an OR tech who speaks fluent Spanish, who speaks fluent Spanish, and Alexander, a thoughtful college student, who is also serving as one of the translators. We stop at a roadside bar, which is really no more than an open shack and drink beer by candlelight as we talk in Spanish to the bartender, a beautiful woman, and her children who stand behind the bar with her. I can say it is the best beer I have ever had -- I get a cold liter bottle of Presidente and we click our bottles and I know already that these people will always be my friends for what we are sharing tonight and this week.

We were told that we were coming to a poor country to help people who have nothing, but what I am starting to believe is that while these people may not have financial wealth, they are richer than many of us for their family bonds, for the love they show each other, and for the joy they take in each day, in breathing the clear mountain air. They have laughter and smiles for each other. You cannot call them poor. In the United States, people work too hard to have more than their neighbors, to consume. We spend too little time with our families. Who is poor and who is rich?